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Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected myocardial infarction. 2018
Janosch Cupa, and
Ivo Strebel, and
Patrick Badertscher, and
Roger Abächerli, and
Raphael Twerenbold, and
Lukas Schumacher, and
Jasper Boeddinghaus, and
Thomas Nestelberger, and
Patrick Maechler, and
Nikola Kozhuharov, and
Maria Rubini Giménez, and
Karin Wildi, and
Jeanne du Fay de Lavallaz, and
Zaid Sabti, and
Lorraine Sazgary, and
Christian Puelacher, and
Deborah Mueller, and
Chiara Bianci, and
Òscar Miró, and
Carolina Fuenzalida, and
Sofia Calderón, and
F Javier Martín-Sánchez, and
Sergio Lopez Iglesias, and
Beata Morawiec, and
Damian Kawecki, and
Jiri Parenica, and
Dagmar I Keller, and
Nicolas Geigy, and
Stefan Osswald, and
Christian Mueller, and
Tobias Reichlin
While prolongation of QRS duration and QTc interval during acute myocardial infarction (AMI) has been reported in animals, limited data is available for these readily available electrocardiography (ECG) markers in humans. Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected AMI in a prospective diagnostic multicentre study were prospectively assessed. Digital 12-lead ECGs were recorded at presentation. QRS duration and QTc interval were automatically calculated in a blinded fashion. Final diagnosis was adjudicated by two independent cardiologists. The prognostic endpoint was all-cause mortality during 24 months of follow-up. Among 4042 patients, AMI was the final diagnosis in 19% of patients. Median QRS duration and median QTc interval were significantly greater in patients with AMI compared to those with other final diagnoses (98 ms [IQR 88-108] vs. 94 ms [IQR 86-102] and 436 ms [IQR 414-462] vs. 425 ms [IQR 407-445], p < 0.001 for both comparisons). The diagnostic value of both ECG signatures however was only modest (AUC 0.56 and 0.60). Cumulative mortality rates after 2 years were 15.9% vs. 5.6% in patients with a QRS > 120 ms compared to a QRS duration ≤ 120 ms (p < 0.001), and 11.4% vs. 4.3% in patients with a QTc > 440 ms compared to a QRS duration ≤ 440 ms (p < 0.001). After adjustment for age and important ECG and clinical parameters, the QTc interval but not QRS duration remained an independent predictor of mortality. Prolongation of QRS duration > 120 ms and QTc interval > 440 ms predict mortality in patients with suspected AMI, but do not add diagnostic value.
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